Friday, June 09, 2006

The use of drugs in cardiovascular medicine is like fashion in clothes design - always changing. The use of Acetylsalicylic Acid (ASA or Aspirin) taken in a small dose daily, has been advocated for many years to reduce the risk heart attacks and strokes. ASA is a platelet inhibitory drug, effective in doses as low as 50 mg per day.

One major shift in 2006 recommendations is based on noticing differences among men and women of different ages. Ridket and Beller pointed out that 95,000 men and women participated in aspirin prevention trials with a net 24% reduction in myocardial infarction and no benefit on stroke; however if you stratify men and women separately, you get 44,000 men with 32% reduction in heart attack. In contrast the 51,000 women had little or no reductions in myocardial infarction, but a significant 19% reduction in the risk of stroke.

A further study looked at the experience of women over the age of 45 more closely. A total of 39,876 women participated in the trial to receive aspirin 100 mg very other day or placebo. The mean follow-up period was 10.1 years. The primary endpoint was first major cardiovascular event, which included nonfatal MI, nonfatal stroke, or cardiovascular death. Secondary endpoints were the individual endpoints of fatal or nonfatal MI, fatal or nonfatal stroke, ischemic stroke, hemorrhagic stroke, and death from cardiovascular causes. Additional analyses included the incidence of death from any cause, transient ischemic attack (TIA), and the need for coronary revascularization.

The characteristics for the groups were similar; participants were 54.6 years of age and more than half were postmenopausal; slightly more than one-quarter were hypertensive and nearly 85% had a 10-year Framingham risk score < 5%. Ridket stated: “Women over the age of 65, have a benefit of stroke reduction associated with low-dose aspirin. In women under age 65, my feelings are go to the gym, lose weight, eat a healthy diet, and maybe the benefit of aspirin is just smaller than we had hoped.”

The 2006 conclusion? ASA has benefits in the primary and secondary prevention of heart attacks in men with little or no benefit in women. Aspirin has a benefit in women over the age of 65 in the prevention of stroke or transient ischemic attacks. What next?

About Me

Stephen is a physician, author, musician and composer. He has written 19 books in the Alpha Education Series that provide guides to managing the most common diseases. Revision of many books are available as 2017 editions. The books are ordered at Alpha Online in either print versions or as eBook downloads.

Alpha Education Books

These books developed gradually from Dr. Gislason's lecture notes and other presentations. In
1991 Dr. Gislason wrote "Nutritional Therapy, his survey of the theory and concepts
behind his method of diet revision. In 1993 Nutritional Therapy Vol. 2 was published
as a large format book that emphasized the practical instructions required to successfully
solve health problems with diet revision. In 1998, the Core Program was transformed
into the Alpha Nutrition Program. A series of texts acted as interfaces to the program,
describing specific health concerns and were first published under the banner of
Alpha Nutrition Health Education, abbreviated to Alpha Education in 2008. Dr. Gislason
has continued to revise and expand these books into informative guides to common
medical problems.

Persona Books

Dr. Gislason had an early start in the study of philosophy and neuroscience.
At age 16, he decided his main life task would be to pursue understanding the human
mind. In the intervening years, he studied neuroanatomy, neurotransmitters,
electronics, computer science, neuropsychology and at the same time he studied
Buddhist philosophy and practiced a variety of meditation techniques.

Music

He is the chief performer, arranger and studio engineer at Persona Digital Studio. He started the 2500 Band in 1996 . The Persona Classical Ensemble was formed in 2007 to arrange and record pieces by JS Bach, Amadeus Mozart and other composers in the classical repertoire. His book Sound of Music was published in Jan. 2011 with a 2017 revision now available.

He has written that singing, dancing and playing music are the best expressions of humans. His review of popular music brings him pleasure and inspiration to develop new compositions. He is most attracted to beautiful ballads, modern jazz and lyrical melodies. He studied piano for many years, beginning a at age 5. As a child, he was immersed in classical music. In high school he started to play the trumpet in bands and continues to play trumpet and flugelhorn parts on the keyboard. In the early 70s, he learned electronics, began building synthesizers and experimented with psychoacoustics. His study of neuroscience integrated nicely with his study of electronic sound processing and sound processing in the brain.